Without the operations, three unborn babies will likely die

Dr. Alireza Shamshirsaz, an Iranian-born professor of obstetrics and gynecology at Baylor College of Medicine, is part of the Texas Children's Fetal Center.﻿

Photo: Courtesy of Texas Children's Hospital

The doctor had waited as long as he could.

For days he had been checking news updates between appointments at Texas Children's Hospital. Waiting to see if the courts or Congress would permanently strike down President Donald Trump's restrictions on travel to the U.S. from seven Middle Eastern countries. Waiting to see if the administration would put out clear guidelines for those planning to go abroad. Hoping.

Now, Dr. Alireza Shamshirsaz felt he had run out of time, and he needed to break it to them.

He dialed in via Skype early this week, and there they were, staring back at him from Iran: The expectant parents whose babies almost certainly would die because he wouldn't be coming to operate on them.

Technically, there was nothing stopping his team from making the trip, he told them. But with uncertainty surrounding the president's travel restrictions — now tied up in federal courts — he and the other doctors weren't certain they would be able to return to Houston at the end of their 10-day visit, so they canceled their flights.

"It was a disaster," Shamshirsaz said, recalling separate video chats with two sets of parents who had been expecting him to perform life-saving surgeries next week on their unborn babies - complicated operations no doctors in Iran can do. "They were sobbing, completely and totally devastated. Now there is no hope for them."

Since Trump's travel ban was announced two weeks ago — an attempt to crack down on potential terrorist attacks from seven predominantly Muslim countries — much has been written about travelers trapped at U.S. airports.

Doctors with green cards stopped by customs officials and sent back to their home countries. Refugees told they wouldn't be coming to the U.S. after all.

Shamshirsaz, 42, an Iranian-born professor of obstetrics and gynecology at Baylor College of Medicine, represents another way people have been affected by the uncertainty surrounding Trump's action: U.S. physicians who were born and studied medicine abroad often make return trips to their home countries to teach doctors techniques they've learned in America, spreading the latest advances in Western medicine across the globe.

Following the chaotic implementation of the president's executive order two weeks ago, Baylor and other medical schools nationwide sent messages cautioning faculty and students against traveling to one of the seven affected countries. Some of the other physicians Shamshirsaz had planned to travel with were adamantly opposed to going until the legal challenges against the order had been settled.

'An impossible decision'

Dr. Alireza Shamshirsaz, an Iranian-born professor of obstetrics and gynecology at Baylor College of Medicine, is part of theÂ Texas ChildrenÂs Fetal Center,Â one of only a handful of centers in the world capable of performing complicated open fetal surgeries.

Photo: Courtesy of Texas Children's Hospital

Even with the decision Thursday by a federal appeals court to keep in place a U.S. district judge's order temporarily blocking the federal government from enforcing Trump's travel ban, there's no telling what the status will be a week or two weeks from now, Shamshirsaz said.

"There's just too much uncertainty right now to know what is the right thing to do," said Shamshirsaz, who worried he'd be stuck in Iran and unable to return to his wife and patients here, who also depend on him. "It was an impossible decision, knowing how this would affect those families in Iran."

Shamshirsaz, known to his patients as "Dr. Shami," specializes in fetal surgeries, an emerging field in which doctors operate on babies in the womb, early in development, to correct deadly birth defects. Texas Children's Fetal Center is one of only a handful of centers in the world capable of performing such operations. Shamshirsaz began making return trips to Iran four years ago to teach others.

In partnership with Tehran University of Medical Sciences and Shiraz University of Medical Sciences, Shamshirsaz created a fellowship program to mentor five Iranian doctors. In 2013, he and his team conducted an open-uterus operation on a fetus in Iran, the first of its kind performed in the Middle East.

Since then, he's returned every few months, usually with a team of colleagues from Texas Children's, each time leading the Iranian fellows through a series of fetal surgeries, building their skills and saving babies' lives in the process.

Shamshirsaz covers the cost of his travel and is paid nothing for the work.

"I do this because it is payback to my country," said Shamshirsaz, whose wife and brother are also Iranian-born doctors practicing in Houston. "As a physician, I trained in Iran, and then I came to the U.S. At some point in your life, you want to do something to give back to the country you come from. Each time I go there, I can save a couple lives. But if I teach these fellows to do these operations, then they can saves thousands of lives."

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Dismayed by order

Shamshirsaz isn't the only physician affected. More than a quarter of U.S. doctors - and more than 32 percent in Texas - were born abroad. Some, like Shamshirsaz, make return trips to their home countries to conduct research and train physicians.

"If you want to have the cutting edge in medicine, these other countries need to have a connection with the U.S." Shamshirsaz said. "That means people on both sides need to go back and forth frequently and freely."

Shamshirsaz was dismayed watching the initial fallout from Trump's executive order, which banned travel from Iran, Iraq, Syria, Sudan, Libya, Yemen and Somalia. He read news reports suggesting that even green card holders like himself weren't being allowed back into this country.

He thought immediately of the expectant mothers he'd planned to operate on this month. One is pregnant with twins suffering from a syndrome in which the babies share a placenta with abnormal blood vessels, causing blood to flow unevenly between the fetuses. Without intervention, both babies will die, Shamshirsaz said.

"They will end up with two dead babies," he said, "and there is nothing else they can do in Iran."

The other mother's baby has been diagnosed with a severely narrow aortic valve, a defect so serious, Shamshirsaz said, it's unlikely the child will survive without intervention in the womb.

For both, there's only a short window to correct the issues, Shamshirsaz said.

Even if he and his team rescheduled the trip for a few weeks from now, he said, it will have been too late.

In a series of tweets over the weekend, Trump criticized the U.S. District Court judge in Washington state who ordered the federal government to temporarily stop enforcing the travel ban until legal challenges are settled.

That order opens a window for those with visas to get back to the U.S., but it offers little clarity for those thinking about taking a trip abroad in the coming weeks.

The president took to Twitter again Thursday evening, reacting to the appeals court decision to uphold the judge's order, setting up a possible showdown before the U.S. Supreme Court.

Meanwhile, Shamshirsaz has another Iran trip planned for May. By then, the president's 90-day executive order will have expired, and he hopes immigration policy will have returned to normal.

"It's hard now," Shamshirsaz said. "One of my major goals of my life is on hold, and it's not clear when I will be allowed to continue it."

Mike Hixenbaugh is an investigative reporter focused on exposing fraud and abuse in health care. Previously, he was a reporter at The Virginian-Pilot in Norfolk, Va., where his work on the military and veterans affairs was co-published with ProPublica, NBC News and the Investigative Reporting Program at UC Berkeley. Mike graduated from the University of Akron in 2007, before going to work for small newspapers in Ohio and then North Carolina.